慢性腎透析患者の消化器外科手術周術期の留意点  [in Japanese] PERIOPERATIVE RISK FACTORS OF HEMODIALYSIC PATIENTS IN GASTROINTESTINAL SURGERY  [in Japanese]

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Abstract

慢性腎透析患者の消化器外科術後の合併症発生と死亡のrisk factorを明らかにするため,消化器外科手術を施行した慢性腎透析患者26例を対象とし,術前,術中,術後の因子を検討した.術後合併症は15例(57.7%),死亡は3例(11.5%)であった.術前のPrognostic Nutritional Index (PNI)が40以下で有意に合併症の発生を認めた.その他の術前因子で,ステロイド服用,術前日血清BUN 50 (mg/dl)以上,術後因子で,術後1日目血清BUN 70 (mg/dl)以上,総蛋白値4.0 (g/dl)以下,縫合不全,腹腔内感染例で死亡率が高かった.これらのrisk factorを認める患者に対し, risk factorを改善する術前管理や縮小手術,姑息的治療法への変更などを考慮すべきと思われた.

Chronic dialysic patients usually have a high rate of surgical mortality and morbidity. Twenty-six dialysis patients were investigated to identify risk factors that the incidence of postoperative complications and death present before, during, and after the operation. Fifteen patients (57.7%) had postoperative complications and 3 (11.5%) patients died after the operation. Patients with a Prognostic Nutritional Index (PNI) value equal to or less than 40 had significantly more postoperative complications. Patients who had taken steroids before the operation and had serum a BUN level equal to or over 50 (mg/dl) one day before the operation, intraperitoneal infections, anastomotic leakages after the operation, serum BUN equal to or over 70 (mg/dl), and serum total protein equal to or under 4.0 (g/dl) one day after operation had significantly higher postoperative mortality. When these risk factors are present, reduction of the operation or selection of non-operative treatment should be considered.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 59(11), 2740-2746, 1998-11-25

    Japan Surgical Association

References:  19

Cited by:  3

Codes

  • NII Article ID (NAID)
    10008437074
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    13452843
  • Data Source
    CJP  CJPref  J-STAGE 
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